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CHAIN OF CUSTODY <br /> www.fgl inc.com AND ANALYSIS REQUEST DOCUMENT <br /> Client: Live Oak Geo Environmental Lab Number: TEST DESCRIPTION AND ANALYSES REQUESTED <br /> Customer Number. 3016608 <br /> Address: 407 W.Oak Street <br /> Lodi, CA 95240 <br /> Phone: (209)369-0375 Fax: (209)369-0375 <br /> Finat7 Address: welehlodi()vahoo.com <br /> Contact Person: David Welch <br /> Project Name: w_0;KwA-+(✓ (� <br /> Purchase Order Number: <br /> b A <br /> Quote Number: <br /> Rush Analysis: E] 5 Day❑4 Day[:J 3 Day❑2 Day❑24 hour E <br /> Rush pre•approval by lab(initab): <br /> Electronic Data Transfer. No State EJCtient Otho: <br /> o <br /> Sampler(s): � <br /> Sampling Fee: Pickup Fee: <br /> Compositor Setup Date: Time: is — <br /> Samp Location Description Date <br /> Num Sampled Sampled <br /> (hair. S-I., lod+ <br /> emarks Relinquished Date: Time: Relinquish Daze: Tinc: Relinquished Date: Time: <br /> -411-1 rC S,�-C- ) <br /> @L P51-2,D)lf <br /> Receiv Date: Time: R e Dale: Time: Received By: Date: Tune: <br /> Corporate otllaeo A Labow twy ounce a Labwaftwy OfHee a warsAay Ot71oe a Labors" Office a Laboratory <br /> 86S Corporation Street 2600 SfWpeoosch Road 583 E.Undo Avenue 3442 Ernpresa Drive.Sulte D 9415 W.Goshen Avenue <br /> Seita Perla•CA 93080 Stotfton CA 96216 Chl o,CA 95928 Sen Luis Obispo.CA 93401 Vis"CA 93291 <br /> TEL(WSP92-2000 TEL:(209)942-0182 TEL:(530)343-6919 TEL:(WS)793-2940 TEL (639)734-9473 <br /> Env FAX(803)6264172/Ag FAX:(806)392-2083 FAX:(209)942-0423 FAX:(630),143.3807 FAX:(805)783-2912 FAX (lkf�734-8435 <br /> CA ELAP Cee0fteabort NMI 573 CA ELAP Certulea8on No.1553 CA ELAP Certification No.2670 CA ELAP Certmaabort No.2775 CA FLAP C.6 W J.No.2810 <br />